Guidance to help with ADT decision.

My dad is looking to me to help him understand treatment risks/tradeoffs.

After reading posts, blogs, and studies, I am now looking for advice on treatment decisions for my dad who was recently diagnosed with unfavorable intermediate-risk prostate cancer. A few case details

1) Age 76

2) PSA: 8

3) Gleason 7 (4+3) (multiple cores taken, 3 were 4+3 and 2 were 3+3)

4) Decipher risk: 0.89

5) PSMA PET: 2 indeterminate pelvic lymph nodes (MRI said lymph nodes were clear). Tumor board said need to treat nodes as positive given Decipher and PET uptake (no SUV values in report)

6) Current health issues: arthritis, high blood pressure, severe sleep apnea, osteopenia, overweight (on glp1).

7) Patient preference: preserve quality of life (while effectively treating the cancer)

*Artera and Tempus XT testing pending

Oncology recommendation: Daily IMRT for 9 weeks to prostate and nearby nodes. Combine with short or long course ADT (Orgovyx was reco’d in the event he does not tolerate). Goal would be ADT for a min of 6 months. He has already said he won’t long course bc of side effects.

From what I’ve read: short course ADT reduces prostate cancer specific mortality by roughly 16% over 15 years, but these benefits seem to pay out late (7-15years post dx). The absolute overall survival benefit is smaller for older men (5-7%) because many men my dad‘s age and status die of other causes before late prostate cancer deaths occur.

I’ve tried to set up the key decision for him as:

Do you want to accept a higher risk of death from prostate cancer death in exchange for your current quality of life today? OR

Do you want to accept a (possibly reversible) quality of life reduction now to potentially reduce your future risk of dying from prostate cancer in 7-15 years.

Am I thinking of this correctly? Thanks to ALL who have helped me think thru this!